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‘Stop Medicaid fraud!’

By Dan HustMONTICELLO  Anxious to find extra cash anywhere they can, legislators on Tuesday spoke with the county’s health and law enforcement leaders about how to cut down on Medicaid fraud.
“Medicaid is the number one cost of Sullivan County government and needs to be monitored and evaluated if we are to survive economically,” said Health Committee Chair Cindy Gieger.
“In 2011, the cost of Medicaid in Sullivan County was $19.5 million in ‘local share,’ $77.2 million in ‘state share,’ and $94.4 million in ‘federal share’,” she explained. “… In 2012 thus far, our local share for Medicaid paid out is $392,499 per week, or $1.6 million per month.”
Statewide, Medicaid fraud accounts for 10-40 percent of costs, Gieger said, and Sullivan County employs nine people to investigate potentially fraudulent applications and payouts.
“Clearly, there is fraud in Sullivan County,” acknowledged Sheriff Michael Schiff, whose deputies work with District Attorney Jim Farrell’s staff to track down and prosecute abusers, be they consumers or providers.
In-house efforts to cut down on Medicaid abuse  intentional and unintentional  saved the county an estimated $16 million last year, yet there was only one fraud case in 2011 and one so far this year.
That’s not necessarily because fraud and abuse have decreased, said Senior Family Services Attorney Colleen Cunningham.
Instead, she said, the state and federal governments have greatly relaxed the “resource” limitations on applicants. As an example, she said someone with a large cache of money in the bank but with a meager income can now legally receive Medicaid benefits.
Still, legislators discussed how to recoup more funds.
“There is a real perception that it’s easier here in Sullivan County” to obtain Medicaid benefits, said Legislator Kitty Vetter, even though the application process is the same statewide.
New Health and Family Services Commissioner Randy Parker guessed that might be due to the county’s proximity to New York City. At his prior job in Ohio, Parker said he saw many people from surrounding urban areas (like Cleveland and Detroit) seek out the shorter waits at more rural offices.
But he agreed that front-end detection  the kind Cunningham and staff now do, albeit with four less staff than a decade ago  should be restructured for even more efficiency and effectiveness.
“We want to change that perception that we’re an easy mark,” Parker said.
Part of that includes more closely monitoring vendors for overbilling, especially those who provide emergency housing for the county’s homeless.
“I think it’s a systemic problem [nationwide],” assessed DA Farrell. “We’re giving everything away, and we shouldn’t be.”
While increasing investigatory staff didn’t seem to be on the table Tuesday, legislators did discuss creating a hotline specifically for fraud allegations. The Sheriff’s Office already has an anonymous crime tips number (807-0158), but Schiff acknowledged that many people don’t think of that for making Medicaid fraud complaints. He indicated an awareness campaign could correct such.
(NYS itself offers an anonymous fraud hotline to the Comptroller’s Office: 1-888-672-4555, available 9 a.m.-5 p.m. Monday through Friday, or by emailing investigations@osc.state.ny.us.)
The county may also look into software geared toward detecting fraud and abuse.
“I think it’s time we send a message out,” urged Gieger.
“… Zero tolerance for any type of fraud or misrepresentation,” agreed Parker.